Project Summary Lung cancer is the second most commonly diagnosed cancer and leading cause of cancer death among men and women in the U.S. Nearly 90,000 people will be diagnosed with metastatic non-small cell lung cancer (NSCLC) this year, representing 40% of lung cancers. One of the more distressing consequences of metastatic NSCLC to patients is its effect on their participation in daily activities and roles. Between 40-65% of lung cancer patients report that impairment in their daily activities and roles is a top unmet supportive care need. This care gap is reflected in existing interventions, which do not directly address function and are not well integrated into primary oncologic care. The overall goal of this research is to address this care gap by implementing a supportive care intervention to help address activity and role function concerns in primary oncologic care. Our research suggests that intervening on patient hope, which reflects agency for pursuing goals and identifying pathways to pursue goals, may be a promising approach to address activity and role function concerns in metastatic NSCLC patients. Informed by our preliminary data, our multidisciplinary team has adapted a hope-enhancing intervention for use with metastatic NSCLC patients in primary oncologic care. The intervention, called Pathways, is based in Hope Theory and comprised of 5 sessions designed to help patients identify meaningful and feasible goals to pursue and increase patient agency and pathways for pursuing goals in the presence of likely disease obstacles, including lung cancer stigma. The intervention is delivered by a nurse with training in supportive care through in-person and phone sessions. The research proposed in this application will evaluate the feasibility of Pathways. In Aim 1, we will refine Pathways by piloting it with 6 metastatic NSCLC patients and conducting interviews with them to evaluate its acceptability and gather suggestions for aspects that need to be improved. Our multidisciplinary team will review the information from Aim 1 and refine Pathways. Then, in Aim 2, we will test the feasibility (patient accrual, adherence, retention, patient acceptability ratings) of Pathways with 20 metastatic NSCLC patients and assess pre-post changes in hope, cancer-related goal interference, and outcome measures related to function and distress. Results of this study will determine the feasibility of a nurse-delivered hope-enhancing intervention to improve function in activities and roles in metastatic NSCLC patients and provide preliminary data to inform a randomized controlled trial of efficacy of the intervention.